Provider Demographics
NPI:1013189216
Name:GREYWOLF, DIANA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:S
Last Name:GREYWOLF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:THETFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05074-0124
Mailing Address - Country:US
Mailing Address - Phone:802-649-2462
Mailing Address - Fax:
Practice Address - Street 1:221 ROUTE 5 S
Practice Address - Street 2:SUITE 1
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9523
Practice Address - Country:US
Practice Address - Phone:802-649-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0051503103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical